Health Assessment
Have you experienced the following Covid 19 symptoms (fever or chills, temperature above 99.5, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, nausea/vomiting, diarrhea, congestion or runny nose?) in the past 14 days?
Yes
No
Have you tested positive for Covid 19 in the past 14 days?
Yes
No
Have you been in close contact with confirmed or suspected (exhibiting symptoms) Covid 19 case in the past 14 days?
Yes
No
Have traveled outside of NY State in less than 15 days
Yes
No
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